Changes to State Fiscal Year 2019–2021 Direct Care Workforce Funding Initiative
Supported employment service providers have been added to the definition of direct care workers. No additional changes were made to this definition.
Providers will no longer be required to complete the quarterly attestation and survey process. However, providers will be required to complete one survey later in 2020 to indicate how the funds are being used and determine the effectiveness of the program. The Wisconsin Department of Health Services (DHS) will distribute this survey and provide notice to providers when it is available.
Specific to COVID-19, supplemental payments to workers above and beyond a worker’s normal reimbursement for hours worked are allowable uses of the direct care workforce funds. Some allowable COVID-19 direct care workforce expenses include, but are not limited to, additional paid time off, hazard pay, increased overtime, and increased weekend and night differentials.
In addition to attestation and survey changes, providers will now have six months to distribute each payment to workers and may claim expenditures made in the prior 12 months as appropriate uses of the direct care workforce funding.
The 2019–21 biennial budget provided $60.3 million in state fiscal year (SFY) 2019–20 and $68 million in SFY 2020–21 for Direct Care Workforce Funding Initiative payments.
This funding is more than double the 2017–19 budget amount.
DHS made the first direct care workforce payment authorized under the 2019–2021 biennial budget in April 2020, following approval from the federal Centers for Medicare & Medicaid Services (CMS), which must authorize these payments.
Below are frequently asked questions about the long-term care Direct Care Workforce Funding Initiative. If you have additional questions or comments, please email us.
What employees are considered direct care workers?
For the purposes of the Direct Care Workforce Funding Initiative, a direct care worker is defined as an employee who contracts with, or is an employee of, an entity that contracts with a managed care organization (MCO) to provide:
- Adult day care services
- Daily living skills training
- Habilitation services
- Residential care (adult family homes of 1–2 beds, adult family homes of 3–4 beds, community-based residential facilities, residential care apartment complexes)
- Respite care services provided outside of a nursing home
- Supportive home care
- Supported employment services
A direct care worker also provides one or more of the following services through direct interaction with members:
- Assisting with activities of daily living or instrumental activities of daily living
- Administering a member’s medications
- Providing personal care or treatments for a member
- Conducting activity programming for a member
- Providing services such as food service, housekeeping, transportation, individual or group supported employment, prevocational employment, or vocational futures planning to the member
Staff not in the definition of direct care worker include, but are not limited to:
- Licensed practical nurses, registered nurses, and nurse practitioners
- Nursing home staff and personal care agency staff
- Staff in marketing, sales, reception, finance, or maintenance and plant operations
- Staff who work exclusively in food service, transportation, and housekeeping and do not have direct contact with members
How will the amount of funding each provider receives be determined?
DHS will determine the specific amount each provider is eligible to receive. Since participation is voluntary, some providers may decline the funding. Payment amounts fluctuate based on the available pool of funding for each payment. Redistribution payment amounts are significantly less than other payment amounts since this funding pool is limited to ineligible and declined funding from the original payment pool.
The amount of funding each provider is eligible to receive will be calculated as follows:
- DHS divides the amount for each payment by the total MCO payments to direct care providers. This determines the payment allocation all direct care providers will receive. For this calculation, DHS assumes all providers are participating in the initiative.
- Finally, DHS multiplies the percentage increase by the payments each provider received during that payment from the MCO it contracts with. The result determines the payment amount to each provider.
Calculation example: If DHS calculates a 1% allocation for all providers and one specific provider received a total of $30,000 from an MCO in payment period, that provider would receive a direct care workforce payment of $300 from the MCO.
How will funding be distributed?
DHS calculates the amount each provider will receive and pays that amount to the MCOs for Family Care and Family Care Partnership.
MCOs will be contractually obligated to pay providers the entire direct care workforce payment received from DHS.
Providers will receive a payment from each MCO they have a current contract with. Providers then pay their direct care workers using the direct care workforce funding received from MCOs.
How were the included dates of service determined?
CMS approval was required prior to making direct care workforce payments for SFY 2019–2020. Once this approval was obtained in early 2020, Q3 of 2019 was determined to be the most recent and most complete dataset for the payment made in April 2020. January and February 2020 was determined to be the most recent and complete dataset for the 2020 payment 1.
When will the first payments be allocated to MCOs?
DHS made the first payments to MCOs in April 2020, with MCOs required to pay providers under the timeline indicated below.
When will providers start to see direct care workforce payments from MCOs for funds appropriated in the 2019-21 state budget?
Below is the timeline for MCOs to distribute funds to providers.
- Payment 1: April 10–April 24, 2020
- Payment 2: June 19–July 3, 2020
- Payment 3: December 2020–early January 2021
- 2019 Redistribution: September 2020
Additional payment details for 2021 will be provided as they become available.
When will subsequent payments be allocated to MCOs?
DHS is finalizing the timeline for subsequent payments. Additional details will be provided as they become available.
Which providers will receive the funding?
The following provider types will receive funding:
Providers of adult day care services, daily living skills training, habilitation services, residential care (adult family homes of 1–2 beds, adult family homes of 3–4 beds, community-based residential facilities, residential care complexes), respite care provided outside of a nursing home, supportive home care services, and supported employment services.
These organization types are not eligible for funding:
- Providers of self-directed services
- Nursing homes, personal care agencies, and MCOs
- Providers that decline to participate in this voluntary program
- Providers that discontinue operations or go into bankruptcy
How will MCOs be held accountable for distributing the funding?
DHS will monitor that the direct care workforce funding amount MCOs pay to each provider matches the amount DHS calculated each provider should receive.
After each payment, MCOs will be required to attest they paid the direct care workforce funding to providers.
MCOs are required to distribute 100% of the direct care payments under the contract between DHS and the MCOs.
What are the distribution requirements for providers?
Sign a contract with MCO
The provider must sign a contract to receive funding from the MCO. The provider must have an active contract with the MCO at the time the funds are distributed. To be eligible for the first payment, the provider must sign and return the direct care worker provider agreement, and the MCO must receive it within 45 days of the date the MCO originally sent the agreement.
Providers are required to distribute funding to direct care workers.
Providers will no longer be required to complete the quarterly attestation and survey process. However, providers will be required to complete one information survey later in 2020 to indicate how the funds are being used and determine the effectiveness of the program.
In the online survey, providers will be required to report how they paid the funding to direct care workers. Examples include wage increases, bonuses, or additional paid time off for direct care workers.
Providers will also need to keep documentation identifying the precise amounts paid to each direct care worker.
How can providers use the funding?
Providers may use the funding to:
- Provide wage increases, bonuses, and/or additional paid time off to direct care workers.
- Pay for employer payroll tax increases that result from increasing workers' wages.
- Some allowable COVID-19 direct care workforce expenses include, but are not limited to, additional paid time off, hazard pay, increased overtime, and increased weekend and night differentials.
Other uses of the funding are not allowed.
Providers will now have six months to distribute each payment to workers and may claim expenditures made in the prior 12 months as appropriate uses of the direct care workforce funding.
Are owner-occupied adult family homes eligible for direct care workforce funding, even if the owner is the only direct care worker at the facility?
Yes. Owner-occupied adult family homes are providing direct care and therefore are eligible for the direct care workforce funding.
Must providers give the direct care workforce funding to staff who provide services only to Family Care or Family Care Partnership members?
No. DHS does not expect providers to have dedicated staff for Medicaid members. Any direct care worker that provided services to a Family Care and Family Care Partnership member in Wisconsin may receive the funding.
Do providers need to spend more than the direct care workforce funding they receive to keep all staff at the same wage or bonus increase?
No. Providers are not required to spend more than the direct care workforce funding. Providers may choose which direct care workers receive the funding, as long as the direct care worker has provided services to a Family Care and Family Care Partnership member in Wisconsin.